Early Cancer of the Stomach

Abstract

In text-books of clinical medicine and pathology one usually finds cancer of the stomach described in its classical advanced form. The early stages are rarely depicted, probably for two reasons: 1. Pathologists who derive their knowledge from autopsy material, rarely, if ever, see small cancers. As a rule patients do not die in the early stages of this disease. 2. Small cancers of the stomach do not give signs and symptoms differing from those of chronic gastric ulcer, duodenal ulcer, and, sometimes, disease of the gall bladder. In my own experience with 3,374 gastric lesions at operation, I have never seen a small cancer (say 2 millimeters in diameter) that was not in the border of a chronic gastric ulcer. This means simply that in a large experience it has not yet been observed; it does not mean that every chronic ulcer is, or will become, a cancer. This large experience teaches also that when a chronic ulcer has a small cancer in its border it does not give differential signs or symptoms by any known clinical method including the X-ray. It is important to emphasize this clinical fact because it, like most clinical facts, is dependent upon actual morbid anatomical findings which constitute the only standards by which they can be interpreted correctly. It may also be said that clinical behavior is our only standard for interpreting morbid anatomical pictures. The two are inseparable.